Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD41319 | TN |
NPI | 1023123643 |
---|---|
Provider Name | Stephen Dumas Hammond JR. |
First Address | Jackson, TN 38302-0400 |
Second Address | Jackson, TN 38301-3951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 11/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3823196 | (05) | TN |
I62587 | (02) |